Alcoholism is also known as "alcohol dependence." It is a
disease that includes alcohol craving and continued drinking despite repeated
alcohol-related problems, such as losing a job or getting into trouble with the
law. Alcoholism includes four symptoms:

Craving--A strong need, or compulsion, to drink.

Impaired control--The inability to limit one's drinking on any
given occasion.

Physical dependence--Withdrawal symptoms, such as nausea, sweating,
shakiness, and anxiety, when alcohol use is stopped after a period of heavy
drinking.

Tolerance--The need for increasing amounts of alcohol in order to
feel its effects.

Alcoholism is now accepted as a disease. It is a chronic and often
progressive disease. Like many diseases, it has symptoms that include a strong
need to drink despite negative consequences, such as serious job or health
problems. Like many diseases, it has a generally predictable course and is
influenced by both genetic (inherited) and environmental factors.

Yes. A person's environment, such as the influence of friends, stress
levels, and the ease of obtaining alcohol, may influence their drinking and the
development of alcoholism. Still other factors, such as social support, may help
to protect even high-risk people from alcohol problems.

Not yet. Alcoholism is a treatable disease, and medication has also
become available to help prevent relapse, but a cure has not yet been found.
This means that even if an alcoholic has been sober for a long time and has
regained health, he or she may relapse and must continue to avoid all alcoholic
beverages.

"Loss of Control" is Real. In
alcoholics, ongoing use alters brain chemistry, causing addiction for which
willpower is no match. Willpower can't lift depression or stop cravings caused
by chemical disruption. Anxiety, irritability, mental confusion, and irrational
thinking are often caused by physical disruption of the brain and central
nervous system. "Talk "cannot reverse these conditions... biochemical
repair must occur.

Alcoholism results in loss of control. Once a drink is
taken after sobriety, the alcoholic cannot control nor predict whether the
drinking will be "normal" or "abnormal." The alcohol
controls the alcoholic -- not vice versa.

Two different types of medications are commonly used to treat
alcoholism. The first are tranquilizers called benzodiazepines (e.g., Valium
and Librium), which are used only during the first few days of treatment to
help patients safely withdraw from alcohol.

A second type of medication is used to help people remain sober. A recently
approved medicine for this purpose is naltrexone (ReVia TM). When used together
with counselling, this medication lessens the craving for alcohol in many people
and helps prevent a return to heavy drinking. Another, older medication is
disulfiram (Antabuse), which discourages drinking by causing nausea, vomiting,
and other unpleasant physical reactions when alcohol is used.

Treatment is effective in many, but by no means all, cases of
alcoholism. Studies show that a minority of alcoholics remain sober 1 year after
treatment, while others have periods of sobriety alternating with relapses.
Still others are unable to stop drinking for any length of time. Treatment
outcomes for alcoholism compare favourably with outcomes for many other chronic
medical conditions. The longer a person abstains from alcohol, the more likely
that person is to remain sober.

It is important to remember that many people relapse once or several
times before achieving long-term sobriety. Relapses are common and do not mean
that a person has failed or cannot eventually recover from alcoholism. If a
relapse occurs, it is important to try to stop drinking again and to get
whatever help is needed to abstain from alcohol. Ongoing support from family
members and others can be important in recovery

No. Even if you are not alcoholic, abusing alcohol can have negative
results, such as the failure to meet major work, school, or family
responsibilities because of drinking, alcohol-related legal trouble, automobile
crashes due to drinking, and a variety of alcohol-related medical problems.
Under some circumstances, even moderate drinking can cause problems--for
example, when driving, during pregnancy, or when taking certain medicines.

More men than women are alcohol dependent or experience alcohol- related
problems. Rates of alcohol problems are also highest among young adults ages
18-29 and lowest among adults 65 years and older. Among major U.S. ethnic
groups, rates of alcoholism and alcohol- related problems vary.

A good first step is to answer the brief questionnaire below. (To help
remember these questions, note that the first letter of a key word in each
question spells "CAGE"):

Have you ever felt you should Cut down on your drinking?

Have people Annoyed you by criticizing your drinking?

Have you ever felt bad or Guilty about your drinking?

Have you ever had a drink first thing in the morning to steady your nerves
or to get rid of a hangover (Eye opener)?

One "yes" answer suggests a possible alcohol problem. More than one
"yes" answer means it is highly likely that a problem exists. If you
think that you or someone you know might have an alcohol problem, it is
important to see a doctor or other health provider right away. He or she can
determine whether a drinking problem exists and, if so, suggest the best course
of action.

That depends. If you are diagnosed as an alcoholic, the answer is
"no." Studies show that nearly all alcoholics who try to merely cut
down on drinking are unable to do so indefinitely. Instead, cutting out alcohol
(that is, abstaining) is nearly always necessary for successful recovery.

However, if studies show that you are not alcoholic but have had
alcohol-related problems, you may be able to limit the amount you drink. If you
cannot always stay within your limit, you will need to stop drinking altogether.

This can be a challenging situation. An alcoholic cannot be forced to
get help except under certain circumstances, such as when a violent incident
results in police being called or following a medical emergency. This doesn't
mean, however, that you have to wait for a crisis to make an impact. Based on
clinical experience, many alcoholism treatment specialists recommend the
following steps to help an alcoholic accept treatment:

Stop all rescue missions. Family members often try to protect an
alcoholic from the results of his or her behaviour by making excuses to
others about his or her drinking and by getting him or her out of
alcohol-related jams. It is important to stop all such rescue attempts
immediately, so that the alcoholic will fully experience the harmful effects
of his or her drinking--and thereby become more motivated to stop.

Time your intervention. Plan to talk with the drinker shortly after
an alcohol-related problem has occurred--for example, a serious family
argument in which drinking played a part or an alcohol- related accident.
Also choose a time when he or she is sober, when both of you are in a calm
frame of mind, and when you can speak privately.

Be specific. Tell the family member that you are concerned about
his or her drinking and want to be supportive in getting help. Back up your
concern with examples of the ways in which his or her drinking has caused
problems for both of you, including the most recent incident.

State the consequences. Tell the family member that until he or she
gets help, you will carry out consequences--not to punish the drinker, but
to protect yourself from the harmful effects of the drinking. These may
range from refusing to go with the person to any alcohol-related social
activities to moving out of the house. Do not make any threats you are not
prepared to carry out.

Be ready to help. Gather information in advance about local
treatment options. If the person is willing to seek help, call immediately
for an appointment with a treatment program counsellor. Offer to go with the
family member on the first visit to a treatment program and/or AA meeting.

Call on a friend. If the family member still refuses to get help,
ask a friend to talk with him or her, using the steps described above. A
friend who is a recovering alcoholic may be particularly persuasive, but any
caring, non-judgemental friend may be able to make a difference. The
intervention of more than one person, more than one time, is often necessary
to persuade an alcoholic person to seek help.

Find strength in numbers. With the help of a professional
therapist, some families join with other relatives and friends to confront
an alcoholic as a group. While this approach may be effective, it should
only be attempted under the guidance of a therapist who is experienced in
this kind of group intervention.

Get support. Whether or not the alcoholic family member seeks help,
you may benefit from the encouragement and support of other people in your
situation. Support groups offered in most communities include Al-Anon, which
holds regular meetings for spouses and other significant adults in an
alcoholic's life, and Alateen, for children of alcoholics. These groups help
family members understand that they are not responsible for an alcoholic's
drinking and that they need to take steps to take care of themselves,
regardless of whether the alcoholic family member chooses to get help.

Most adults can drink moderate amounts of alcohol -- up to two drinks
per day for men and one drink per day for women and older people -- and avoid
alcohol-related problems. (One drink equals one 12-ounce bottle of beer or wine
cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.)

Certain people should not drink at all. They include women who are
pregnant or trying to become pregnant; people who plan to drive or engage in
other activities requiring alertness and skill; people taking certain
medications, including certain over-the-counter medicines; people with medical
conditions that can be worsened by drinking; recovering alcoholics; and people
under the age of 21.

No. Drinking during pregnancy can have a number of harmful effects on
the newborn, ranging from mental retardation, organ abnormalities, to
hyperactivity and learning and behavioural problems. Moreover, many of these
disorders last into adulthood.

While we don't yet know exactly how much alcohol is required to cause these
problems, we do know that they are 100% preventable if a woman does not drink at
all during pregnancy. Therefore, for women who are pregnant or are trying to
become pregnant, the safest course at present is to abstain from alcohol.

Yes. As a person ages, certain mental and physical functions tend to
decline, including vision, hearing, and reaction time. Moreover, other physical
changes associated with aging can make older people feel "high" after
drinking fairly small amounts of alcohol. These combined factors make older
people more likely to have alcohol- related falls, automobile crashes, and other
kinds of accidents.

In addition, older people tend to take more medicines than younger persons,
and mixing alcohol with many over-the-counter and prescription drugs can be
dangerous, even fatal. Further, many medical conditions common to older people,
including high blood pressure and ulcers, can be worsened by drinking. Even if
there is no medical reason to avoid alcohol, older men and women should limit
their intake to one drink per day.

Yes. Women become more intoxicated than men after drinking the same
amount of alcohol, even when differences in body weight are taken into account.
This is because women's bodies have proportionately less water than men's
bodies. Because alcohol mixes with body water, a given amount of alcohol becomes
more highly concentrated in a woman's body than in a man's. That is why the
recommended drinking limit for women is lower than for men.

In addition, chronic alcohol abuse takes a heavier physical toll on women
than on men. Alcohol dependence and related medical problems, such as brain and
liver damage, progress more rapidly in women than in men.

Several studies have reported that moderate drinkers -- those who have
one or two drinks per day -- are less likely to develop heart disease than
people who do not drink any alcohol or who drink larger amounts. Small amounts
of alcohol may help protect against coronary heart disease by raising levels of
"good" HDL cholesterol and by reducing the risk of blood clots in the
coronary arteries.

If you are a non-drinker, you should not start drinking only to benefit your
heart. Protection against coronary heart disease may be obtained through regular
physical activity and a low-fat diet. And if you are pregnant, planning to
become pregnant, have been diagnosed as alcoholic, or have any medical condition
that could make alcohol use harmful, you should not drink.

For those who can drink safely and choose to do so, moderation is the key.
Heavy drinking can actually increase the risk of heart failure, stroke,
and high
blood pressure, as well as cause many other medical problems, such as liver
cirrhosis.

Possibly. More than 100 medications interact with alcohol, leading to
increased risk of illness, injury and, in some cases, death. The effects of
alcohol are increased by medicines that slow down the central nervous system,
such as sleeping pills, antihistamines, antidepressants, antianxiety drugs, and
some painkillers. In addition, medicines for certain disorders, including
diabetes and heart disease, can be dangerous if used with alcohol. If you are
taking any over-the-counter or prescription medications, ask your doctor or
pharmacist whether you can safely drink alcohol.

In the U.S. you can call the Center for Substance Abuse Treatment at
1-800-662-HELP for information about alcohol treatment programs in your local
community and to speak to someone about an alcohol problem, or visit the Alcoholics
Anonymous web site.

This article incorporates information provided by the National Institute on
Alcohol Abuse and Alcoholism (NIAAA), one of 18 institutes that comprise the
National Institutes of Health (NIH), the principal biomedical research agency of
the U.S. Government.

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